Levemir (insulin detemir)

How does it work?

Levemir prefilled pens (FlexPen and InnoLet) and penfill
cartridges (for use with NovoPens) all contain the active ingredient insulin
detemir. They are used to treat diabetes.

People with diabetes have a deficiency or absence of a hormone
manufactured by the pancreas called insulin. Insulin is the main hormone
responsible for the control of sugar (glucose) in the blood.

People with type one diabetes need to have
injections of insulin to control the amount of glucose
in their bloodstream. Insulin injections act as a replacement for natural
insulin, and allow people with diabetes to achieve normal blood glucose levels.

Insulin injections work in the same way as natural insulin, by
binding to insulin receptors on cells in the body. Insulin causes cells in the
liver, muscle and fat tissue to increase their uptake of glucose from the
bloodstream. It also decreases the production of glucose by the liver, and has
various other effects that lower the amount of glucose in the blood.

The type of insulin in this medicine is called insulin detemir.
This is known as a long-acting insulin. It is injected under the skin, where it
forms a reservoir of insulin that is released slowly over a period of up to 24
hours, depending on the dose. The injection can be given once or twice daily to
give a background control of blood glucose levels throughout a 24 hour period.
Insulin detemir is normally used in combination with a short-acting insulin,
which is given before meals to control the increase in blood glucose that
happens after eating.

It is important to monitor your blood glucose regularly and
adjust your insulin dose as required. Your doctor or diabetic team will explain
how to do this. Keeping your blood glucose level as close to normal as
possible, and not too high or too low, significantly reduces the risk of
developing late-stage diabetic complications.

What is it used for?

How do I use it?

Your doctor or diabetes specialist will teach you how to administer your insulin injections correctly. Make sure you understand what to do and ask questions if you don't.

Levemir injections are usually given under the skin of the upper arms, thighs, buttocks, or abdomen. You should take care to make sure that the injection does not enter a blood vessel. The injection may start to start to work at different speeds depending on the site you use and various other factors, such as if you have been doing exercise. In general, injections into the abdomen start to work quicker than those given in other areas. You shouldn't massage the injection area after administering an injection.

Each time you inject your insulin make sure you use a different site. This helps to prevent the skin thickening and pitting, which can occur if the injection is repeatedly given in the same site.

You should measure your blood sugar levels every day when using insulin injections. The dose you need to inject each time will depend on your blood sugar levels, what you are going to eat and if you have been doing or will be doing exercise. Control of blood sugar is an individual process and your diabetes specialist will help you to understand what is required.

Your insulin requirements may increase when you are ill, especially if you have an infection or fever. Your insulin dose may also need adjusting during periods of emotional disturbance, or if you increase your physical activity or change your usual diet. Insulin requirements may be reduced if you have impaired kidney or liver function. Discuss this with your doctor or diabetes nurse to make sure you optimise control of your blood sugar.

Warning!

Levemir must not be injected into a vein
(intravenously).

Low blood sugar
(hypoglycaemia) can often occur as a side effect of insulin therapy.
This is more likely to happen if you suddenly do more exercise than normal,
have your meals at irregular times, eat less than usual, or miss meals
altogether. For this reason, it is important that you follow any dietary or
exercise advice given to you by your doctor. You should also make sure you are
aware of the symptoms of hypoglycaemia (these usually occur suddenly and may
include cold sweats, cool pale skin, tremor, anxious feeling, unusual tiredness
or weakness, confusion, difficulty in concentration, excessive hunger,
temporary vision changes, headache, nausea and palpitations) and what to do if
you experience these symptoms. Discuss this with your GP, pharmacist or
diabetes specialist. You should also be aware that if your blood sugar control
is greatly improved, for example by intensified insulin treatment, your usual
warning symptoms of low blood sugar may change.

Your ability to concentrate or react may be reduced if you have
low blood sugar, and this can cause problems driving or operating machinary.
You should take precautions to avoid low blood sugar when driving - discuss
this with your doctor.

People with diabetes who are on insulin should only drink
alcohol in moderation and accompanied by food. This is because alcohol can make
your warning signs of low blood sugar less clear, and can cause delayed low
blood sugar, even several hours after drinking.

People with diabetes who smoke normally need more insulin, as
smoking reduces the amount of insulin that is absorbed into the blood from an
injection under the skin. If you give up smoking, you may subsequently need a
reduction in your insulin dose. Discuss this with your doctor. (If you are
diabetic
giving up smoking is one of the most important things
you can do, because it will vastly reduce your risk of complications like heart
disease and circulatory problems.)

Your insulin should only be changed on your doctor's advice. If
you do transfer to a different insulin, eg different type (short, intermediate
or long acting), different species (human or animal), different brand, or
different strength of insulin, your doctor may need to alter your dose, and
your warning symptoms of low blood sugar may be slightly different.

Use with caution in

Not to be used in

The safety and effectiveness of Levemir have not been studied in
children under two years of age. It is not recommended for this age group.

This medicine should not be used if you are allergic to one or
any of its ingredients. Please inform your doctor or pharmacist if you have
previously experienced such an
allergy.

If you feel you have
experienced an allergic reaction, stop using this medicine and inform your
doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

This type of insulin should be used with caution during pregnancy because its safety has not been fully established. A different type of long-acting insulin with known safety during pregnancy may be preferable, but you should discuss this with your doctor. Blood sugar levels need to be maintained as stable as possible during pregnancy, and you should consult your diabetic specialist to discuss how to achieve this. Your insulin requirements are likely to decrease in the first trimester and subsequently increase in the second and third trimesters. Discuss this with your doctor.

There is no risk to nursing infants from insulin taken by the mother. This is because if any insulin does pass into the breast milk it will be broken down by the digestive enzymes in the baby's gut. However, the mother's insulin dose may need to be decreased during breastfeeding. Discuss this with your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Very common (affect more than 1 in 10 people)

Low blood glucose level (hypoglycaemia) - see warning section above.

Common (affect between 1 in 10 and 1 in 100 people)

Redness, swelling or itching at the injection site.

Uncommon (affect between 1 in 100 and 1 in 1000 people)

Skin thickening or pitting (lipodystrophy) if injection given too frequently into the same site.

Very rare (affect less than 1 in 10,000 people)

Allergic reaction (hypersensitivity), such as skin rash or itching, hives, chest tightness, shortness of breath or severe allergic reactions such as anaphylaxis.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

Insulin itself doesn't affect other medicines. However, it is important to be aware that many medicines can affect blood glucose levels and can therefore change your insulin requirements. For this reason, people with diabetes should always seek advice from their doctor or pharmacist before taking any new medicines or stopping existing ones.

The following medicines may decrease blood sugar levels. If you start treatment with any of these your insulin dose may therefore need decreasing:

large doses of salicylates, eg aspirin (small pain relieving doses do not normally have this effect).

Beta-blockers, eg propranolol (including eye drops containing beta-blockers) can mask some of the signs of low blood sugar, such as increased heart rate and tremor. They also prolong episodes of low blood sugar and impair recovery back to normal glucose levels.

The following medicines may increase blood glucose levels. If you start treatment with any of these your insulin dose may therefore need increasing:

some antipsychotic medicines, eg chlorpromazine, olanzapine

corticosteroids, eg hydrocortisone, prednisolone

danazol

diuretics, especially thiazide diuretics, eg bendroflumethiazide

isoniazid

lithium

protease inhibitors, eg ritonavir

somatropin (human growth hormone).

Oestrogens and progestogens, such as those contained in oral contraceptives, may affect blood sugar levels, and women taking these may need small adjustments up or down in their insulin dose.

How do I store Levemir?

Before opening, Levemir penfill cartridges, FlexPens and
InnoLet pens should be stored in their outer cartons in a refrigerator at
2-8°C. Do not freeze. Make sure the containers do not directly touch the
freezer compartment. Once in use the cartridges and pens should be kept outside
the fridge, but must be kept below 30°C. You should keep the cap on
FlexPens and InnoLet pens that are not in use to protect the insulin from
light. The pens should not be stored with the needle attached.

Any unused medicine should be discarded six weeks after the first use.
You may find it helpful to write the date of first use on the label.

Make sure all medicines are kept out of the reach of children and avoid exposing them to excessive heat or direct sunlight.

Other medicines containing the same active ingredient

There are currently no other products available in the UK that
contain this kind of insulin (insulin detemir).

There are many other forms of insulin available; you can read about these here.

The materials in this web site are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor. The web site does not have answers to all problems. Answers to specific problems may not apply to everyone. If you notice medical symptoms or feel ill, you should consult your doctor - for further information see our Terms and conditions.